Nursing Home Emergency Preparedness: New CMS Checklist and Proposed Regulations

Following recent natural and man-made disasters such as 9/11, Hurricane Katrina, and other floods and fires, the federal government has increased its focus on emergency preparedness. Federal regulations – 42 C.F.R. § 483.75(m) – require that Medicare- and Medicaid-certified nursing homes have written emergency plans and provide employees with emergency preparedness training.

In a 2012 report, the Office of Inspector General (OIG) reviewed state survey data for emergency preparedness in nursing homes. Although most long-term care facilities had emergency plans, the majority of the plans were wholly inadequate. Half of the sampled plans contained only 50 percent of the CMS-recommended checklist items, according to the OIG’s “Gaps Continue to Exist in Nursing Home Emergency Preparedness and Response During Disasters: 2007-2010.”

On February 28, 2014, CMS issued Survey and Certification Letter S&C-14-12, a revised emergency preparedness checklist. Some of the key items in the checklist are the following:

Collaborate with local emergency management agency: Work with local emergency management agencies to ensure the development of an effective emergency management plan.

Analyze each hazard: Analyze the specific vulnerabilities of the facility and determine actions for each identified hazard.

Decision criteria for executing plan: Include factors to consider when deciding whether to evacuate and shelter in place. Determine decision-maker, and chain of command.

Develop shelter-in-place plan: Provide for various emergency measures, such as assessing whether the facility can withstand the threat, measures to secure the building, at least seven days worth of resources such as food and power, and security plan.

Communication infrastructure contingency: Develop communication plan in the event of telephone failures, such as walkie-talkies and ham radios.

Concluding that current emergency preparedness regulatory requirements are not comprehensive enough to address the complexities of actual emergencies, CMS issued a proposed rule that 17 different providers and suppliers must meet to participate in the Medicare and Medicaid programs. “Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers,” 78 Fed. Reg. 79081 (Dec. 27, 2013). The proposed rule addresses the following gaps that CMS believes exist in the current regulations: (1) communication to coordinate with other systems of care with local jurisdictions; (2) contingency planning; and (3) personnel training.

Because long-term care facilities are unique among other health care providers as many of the residents can be expected to have long-term or extended stays, the proposed rule also requires these facilities to develop an emergency preparedness communication plan. The emergency preparedness communication plan would include a means of providing information about the general condition and location of residents under the facility’s care.

Finally, the proposed rule for long-term care facilities also requires emergency plans to utilize an “all-hazards” approach, which, in an emergency situation, would include a directive to account for missing residents.

In light of the new checklist and CMS’ recent focus on emergency preparedness, health care providers, including nursing homes, should evaluate their emergency preparedness plans. In addition, facilities should look out for new emergency preparedness regulations.

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